Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 8859872-1205 | UT |
NPI | 1003107558 |
---|---|
Provider Name | Dr. David Justin Beckstead |
First Address | Spanish Fork, UT 84660-2060 |
Second Address | Spanish Fork, UT 84660-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2011 |
Last Update Date | 12/11/2015 |